Zika is scary. It most significantly and publicly affects women of child-bearing age and has enormous health implications for moms and babies. It’s an emerging public health threat in the Western Hemisphere, so we haven’t had time to study it exhaustively, and our public health infrastructure isn’t yet used to it. Many people will never exhibit symptoms, which means that they could potentially transmit Zika without even knowing they had it. Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC), has called the Aedes aegypti (one of the vectors for Zika) the “cockroach of mosquitoes” because it’s so hard to kill. With mosquito season fast-approaching, folks are understandably looking for guidance from public health officials to respond to this threat.

In February, the Obama administration requested from Congress $1.9 billion in supplemental, emergency funding to combat the Zika virus through a comprehensive approach: prevention and mosquito control; development of and access to therapeutics; further study into the biological implications of Zika and its transmission; and funding to the states so that they can attack the threat. The request also includes additional funding to Medicaid in Puerto Rico and other U.S. territories to support pregnant women at-risk or who have contracted Zika, children with microcephaly, and to cover other healthcare costs.

After more than 40 congressional hearings this year, the good news is that lawmakers from both sides of the aisle agree that the Zika threat justifies new funding. The bad news is, three months after the White House's initial request, there remains little agreement about how much funding to provide, for what, when to provide it, and through what mechanism. But while Congress debates the details, public health agencies can't afford to wait. The administration has been forced to redirect nearly $600 million previously allocated to fight the ongoing Ebola threat toward the Zika efforts--under the assumption that this funding will eventually be made whole by Congress in the Zika package--as well as $44 million from emergency preparedness grants intended for use by the states. As the Washington Post recently reported, the reallocation of these Public Health and Emergency Preparedness (PHEP) funds is particularly concerning because that money is critical for states to address ongoing and emerging public health crises such as outbreaks and natural disasters in real time. As Cynthia Harding, Interim Director of the Los Angeles Department of Public Health told The Post, "this is stealing from Peter to pay Paul."

So what's the hold up?

Many Republicans remain skeptical of the administration's request, asserting that they need additional information about how the funds will be used before they will appropriate them. Lawmakers in the House are arguing that the regular appropriations process is the appropriate pathway for funding these activities. Speaker Paul Ryan has suggested that any funding to combat Zika must be budget neutral, that is, offset by cuts to other federal programs. Republican colleagues in the Senate, however, are moving forward with an emergency supplemental, the details of which aren't yet available. Meanwhile, Democrats insist "enough is enough," and are calling on their colleagues to enact the President's request for emergency funding now and introduced a bill last week to fully fund the President's request.

Zika is pressing. In doing the necessary and immediate work of responding to Zika, however, lawmakers should not ignore the underlying public health infrastructure that has been neglected and is in dire need of repair. We need to keep training our public health workforce, reinvesting in early warning systems, and to continue our upkeep of preventive and responsive public health services on a state and local level. We need Congress to support supplemental funding for Zika now, and to continue to support the public health system that protects us against the next Zika that has yet to emerge.

Here at CRD Associates, we are closely monitoring efforts to support Zika research, prevention, and response. Many of our clients are directly impacted by Zika. Some treat moms and babies, some are public health practitioners, and some are patient advocacy groups, concerned about how the lack of data about blood-borne transmission will implicate their patients. At CRD, we are proud to help our clients join the voices of other patient, medical, and advocacy groups in supporting supplemental Zika funding, and to aid them in sharing their unique expertise to help government officials navigate this complex public health space.

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